366425270-4-10-2023-56-AS-NBRN-CQTMCT-20230412093000

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366425270
Report Date: 04/10/2023
Date Signed: 04/10/2023 11:31:26 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/07/2023 and conducted by Evaluator Anna Bueno

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230407124518

FACILITY NAME:	ABRIA DEL CIELO		FACILITY NUMBER:	366425270
ADMINISTRATOR:	CRISELDA ESPIRITU SANTO		FACILITY TYPE:	740
ADDRESS:	1589 N. WATERMAN AVE		TELEPHONE:	(909) 884-4757
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92404
CAPACITY:	240	CENSUS: 133	DATE:	04/10/2023
		UNANNOUNCED	TIME BEGAN:	10:58 AM
MET WITH:	May Cabrera - Administrator		TIME COMPLETED:	11:34 AM

ALLEGATION(S):

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Staff did not prevent a resident from attacking another resident while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to initiate the complaint investigation and deliver findings on the above allegation. LPA met with administrator May Cabrera and assistant administrator Kevin Villacorte who were informed of the purpose of today’s visit. The investigation consisted of staff interviews and review of relevant records.

It is alleged that Staff did not prevent Resident 2 (R2) from attacking another Resident 1 (R1) while in care. Staff interviews and records confirmed that R1 was residing at this facility from 4/17/2014 through 11/20/2019. Interviews with staff deny that R2 lived at this facility and staff have never heard of R2 before today's visit. Staff further state that R1 was friendly with staff and other residents and staff do not recall any altercations between R1 and other residents. LPA found incident reports involving R1 but LPA could not find any reports mentioning R2 from this facility. This allegation is therefore unfounded.

A finding of UNFOUNDED means that the allegation is false, could not have happened and/or is without a reasonable basis. An exit interview was conducted where this report was discussed, and a copy provided to Kevin Villacorte.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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